Takayasuarteritis (TA) is a chronic, nonspecific inflammatory disease that primarily involves the walls of the large arteries and can cause narrowing or even obstruction of the lumen. The disease mainly involves the aorta and its major branches and therefore may affect the blood supply to the head, upper extremities, lower extremities, and internal organs for unknown reasons. It is also known as “pulselessness” because the arterial pulses in the upper or lower extremities may be weakened or absent. Feng Xiang, Department of Vascular Surgery, Shanghai Changhai Hospital The disease is most common in young women under the age of 30, and has a higher incidence in China and East Asian countries such as Japan and Korea. It can be divided into four types according to the lesion site: 1. Head and arm artery type: Narrowing and occlusion of carotid and vertebral arteries can cause different degrees of cerebral ischemia, dizziness, vertigo, headache, memory loss, black spots in unilateral or bilateral vision, vision loss, visual field reduction or even blindness, masticatory muscle weakness and chewing pain. A few patients have nasal septal perforation, ulceration of palate and auricle, tooth loss and facial muscle atrophy due to local ischemia. Severe cerebral ischemia may result in recurrent syncope, convulsions, aphasia, hemiparesis or coma. Upper limb ischemia may present with unilateral or bilateral upper limb weakness, coldness, aching, numbness, and even muscle atrophy. The carotid artery, radial artery and brachial artery pulsation is weakened or disappeared, which is manifested as “pulseless sign”. 2. Thoracic-abdominal aorta type: Due to ischemia, the lower limbs show symptoms such as weakness, aching, cold skin and intermittent claudication, especially when the iliac artery is involved, the symptoms are most obvious. Hypertension occurs with renal artery involvement and may include headache, dizziness, and palpitations. Hypertension is an important clinical manifestation of this type, especially elevated diastolic blood pressure is obvious, mainly renal vascular hypertension caused by renal artery stenosis; in addition, severe stenosis of the thoracic descending aorta, so that most of the blood discharged from the heart flows to the upper extremities, which can cause segmental hypertension; aortic valve closure insufficiency leads to systolic hypertension, etc. In simple renal vascular hypertension, its systolic blood pressure in the lower extremities is 20-40 mmHg higher than that in the upper extremities. 3.Mixed type: with the characteristics of the above two types, it is a multiple lesion, and most patients are in serious condition. 4, pulmonary artery type: the disease combined with pulmonary artery involvement is not uncommon, accounting for about 50%, the above three types can be combined with pulmonary artery involvement, and there is no significant difference between the types with or without pulmonary artery involvement, simple pulmonary artery involvement is rare. Pulmonary hypertension is mostly a late complication, accounting for about 1/4 of cases, and is mostly mild or moderate, while severe cases are rare. Clinically, palpitations, shortness of breath and, in severe cases, heart failure are present. A systolic murmur and a hyperactive second pulmonary valve sound can be heard in the pulmonary valve region. When does polyarteritis require surgical treatment? Polyarteritis is an immune disease and surgical treatment is not causative. The primary treatment during the active phase of inflammation is glucocorticoids or immunosuppressive agents. The reduction of glucocorticoids is usually indicated by the normalization of blood sedimentation and C-reactive protein, and should be maintained for a long period of time when the dose is reduced to 5-10 mg daily. Vascular bypass or stenting? After the inflammation has stabilized, the stenosis caused by inflammation can cause ischemia in the corresponding target organs, resulting in cerebral infarction, renal vascular hypertension, and renal failure, which then requires surgical management of the stenosed vessels. Because the stenotic lesion in multiple aorta is an inflammatory scar stenosis of the whole vessel, in stentoplasty, dilatation of the diseased vessel leads to tearing of the inflammatory scar and consequently to re-inflammatory scar repair of the diseased vessel, the long-term results of treatment of multiple aorta with stentoplasty or balloon dilatation are poor compared with those of atherosclerotic stenosis. In contrast, surgical bypass procedures, such as ascending to internal carotid artery bypass and abdominal to renal artery bypass, avoid irritation of the inflamed stenotic vessels, and their long-term results are more reliable.